Disproportionate Share Payments Fraud
these are additional payments made to hospitals that treat a disproportionate share of low-income patients, to offset losses from treating these patients. A hospital meets the threshold for DSH payment if its low-income patient share exceeds 15%. The low-income patient share is calculated by adding: (i) the proportion of a hospital’s Medicare inpatient days to the number of patients eligible for Supplemental Security Income benefits to (ii) the proportion of a hospital’s total acute inpatient days furnished to Medicaid patients. The formulas and criteria to determine the adjustment factor are complex and subject to manipulation, and therefore ripe for fraud.